Evaluation of Th1/Th2 cytokines as a rapid diagnostic tool for severe infection in paediatric haematology/oncology patients by the use of cytometric bead array technology
Evaluation of Th1/Th2 cytokines as a rapid diagnostic tool for severe infection in paediatric haematology/oncology patients by the use of cytometric bead array technology
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DOI：
10.1111/j.1469-0691.2011.03490.x
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发表时间：
2011-11-01
影响因子：
14.2
通讯作者：
Pan, B.
中科院分区：
文献类型：
--
作者：
Tang, Y.;Liao, C.;Pan, B.
血液学/肿瘤学儿童在强化化疗后通常有各种感染的危险。我们对795例住院血液科/肿瘤科儿童（309例发热患者和486例发热患者）的Th1/Th2细胞因子定量进行了流式细胞术头阵列（CBA）评估，以寻求一种确定感染类型和严重程度的诊断方法。309例发热患者共出现505次发热发作。在145/505例发热发作中，微生物学检查显示血培养阳性（微生物记录感染（MDI））。对照组为健康儿童550例，嗜血球淋巴组织细胞增多症（HLH）患者43例，巨细胞病毒感染患者35例，eb病毒感染患者19例。发热期患儿白细胞介素(IL)-4、IL-6、IL-10、肿瘤坏死因子(TNF)- α和干扰素(IFN)- γ水平显著高于健康患儿，且细胞因子谱与HLH对照组或病毒感染对照组存在差异。MDI患者IL-6水平明显高于HLH患者（2/43）（通常为100 ~ 1000.0 pg/mL, 60/145）；然而，MDI患者的ifn - γ水平仅略有升高，很少超过100.0 pg/mL （8/145 vs. HLH患者的39/43）。发热患者在抗生素治疗前IL-4、IL-6、IL-10、tnf - α和ifn - γ的中位水平分别为3.9、660.1、122.7、6.9和11.4 pg/mL，感染控制后分别恢复到3.3、22.8、9.6、4.1和6.4 pg/mL。IL-6和IL-10水平与脓毒性休克和死亡率呈正相关。总之，我们的研究结果证明了利用CBA技术检测IL-6/IL-10/ tnf - α / ifn - γ对发热血液病/肿瘤病儿童的早期快速诊断、严重程度评估和治疗效果评估的有效性。
Haematology/oncology children are usually at risk for various infections after intensive chemotherapy. We evaluated the quantification of Th1/Th2 cytokines with a flow cytometric bead array (CBA) in 795 hospitalized haematology/oncology children (309 febrile and 486 afebrile patients) to seek for a diagnostic method for determination of the type and the severity of infection. Three hundred and nine febrile patients developed a total of 505 febrile episodes. Microbiological examination demonstrated a positive blood culture (microbiologically documented infection (MDI)) in 145/505 febrile episodes. The controls included 550 healthy children, 43 haemophagocytic lymphohistiocytosis (HLH) patients, 35 cytomegalovirus infection patients and 19 Epstein-Barr virus infection patients. Interleukin (IL)-4, IL-6, IL-10, tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma levels in febrile episodes were significantly higher than those in healthy children, and the cytokine profile was different from that of the HLH controls or the viral infection controls. IL-6 levels were much higher in MDI patients (usually > 1000.0 pg/mL, 60/145) than in HLH patients (2/43); however, IFN-gamma levels were only slightly increased in MDI patients, rarely being more than 100.0 pg/mL (8/145 vs. 39/43 in HLH patients). The median levels of IL-4, IL-6, IL-10, TNF-alpha and IFN-gamma in febrile patients before antibiotic therapy were 3.9, 660.1, 122.7, 6.9 and 11.4 pg/mL, respectively, and returned to 3.3, 22.8, 9.6, 4.1 and 6.4 pg/mL, respectively, after infection was controlled. IL-6 and IL-10 levels were positively associated with septic shock and mortality rates. In conclusion, our results have demonstrated the usefulness of IL-6/IL-10/TNF-alpha/IFN-gamma determination with CBA technology for the early rapid diagnosis, severity evaluation and assessment of therapy effect in febrile haematology/oncology children.